Vancouver doctors reach out to homeless youth battling mental illness

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For a young person coping with mental illness, life can be full of obstacles, but for those living on the streets getting help can often be the biggest challenge. A new program is helping address this issue by taking mental health treatment into the community to reach homeless youth.

The Inner City Youth Mental Health Program, started by Providence Health Care psychiatrists, Dr. Steve Mathias and Dr. Bill MacEwan, began as a pilot project in 2007 by linking psychiatrists from Vancouver’s St. Paul’s Hospital with youth at the Covenant House – a non-profit organization that provides shelter and a wide range of services for homeless youth. Formalized this year, the program has grown to include eight psychiatrists, a social worker and a coordinator.

It’s estimated that there are currently 700 homeless youth living on the streets of Vancouver and many of them struggling with addiction. About 60 to 65 per cent of these young people have been through foster care and as many as 50 per cent are dealing with emerging mental health issues.

According to Dr. Mathias, a large gap exists between child and youth mental health services and adult services, causing many youth to struggle to access treatment between ages 17 and 19. Adult services are also not necessarily designed for the specific needs of those under age 25.

In addition to the lack of coordination between services, characteristics of this hard-to-reach population also make it more difficult for them to get help. These youth are transient and difficult to identify. Many also have co-occurring substance use disorders and are often turned away from other treatment programs. “We decided to create a more assertive model and take mental health and psychiatric services outside the hospital to where the kids are,” explains Dr. Mathias. “We wanted to bridge the gap in services and help the kids transition into adulthood.”

The program targets youth ages 16 to 24 and in the first year, 120 young people were referred to the program. Many were homeless since they were 13 or had been through dozens of homes. About a third of the youth had very severe illness, and many struggled with other traumas. “Several had been beaten or abused by family members or partners. They had been involved in the drug trade and had experienced things that were pretty horrific,” says Dr. Mathias.

“Through this program we see the most challenging family and developmental histories that I come across in clinical work,” says Dr. Dan Lin, a St. Paul’s psychiatrist. “These youth have a complex mix of social circumstance, psychopathology and substance use issues. We work to tease these apart to try and understand in order to work with these youth.”
Initially, the program was crisis-driven, but soon evolved to a more preventative approach and provided therapy for young people who were struggling with anxiety disorders, depression and other mental health issues.

“We found that just below the crisis level, there was a large group of youth struggling just to get through the day. They weren’t functioning the way we’d hope; they weren’t attending school, couldn’t hold down a job, they were homeless,” says Dr. Mathias. “This is a group that for many years has gone without specific psychiatric services, yet is the group that five, ten or fifteen years from now, we’ll see filling our hospital beds and homeless or drug addicted in the Downtown Eastside.”

The partnership provides support for Covenant House for youth they previously didn’t know where to send for help. “This program has made an immense difference,” says Tracy Brown, the mental health clinician at Covenant House who works closely with the St. Paul’s team. “Our youth are being diagnosed and treated by a doctor, and that allows them to look at their life, re-evaluate their life and to set goals to go forward.”

Youth in the program are staying in shelter about three times the seven-day average length of stay. In this time youth gain more stability and develop more trust and relationships with the doctors, Covenant House and themselves. “Many of them have never experienced being cared for this way, and they really grow as individuals. The results are amazing,” says Brown.